<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta name = "viewport" content = "width = 1280">
<title>Register</title>
<link rel="stylesheet" href="../../style.css" media="screen" />
<link rel="stylesheet" href="../../scripts/jquery.ui/theme/smoothness/jquery-ui-1.8.6.custom.css" media="screen" />
<link rel="stylesheet" href="../../css/register.css" media="screen" />
<link rel="stylesheet" href="../../scripts/jquery.validate/validate.css" media="screen" />
<script type="text/javascript" src="../../scripts/jquery.min.js"></script>
<script type="text/javascript" src="../../scripts/jquery.ui.min.js"></script>
<script type="text/javascript" src="../../scripts/jquery.easing.1.3.js"></script>
<script type="text/javascript" src="../../scripts/jquery.validate.min.js"></script>
<script type="text/javascript" src="../../scripts/common.js"></script>
<script type="text/javascript" src="../../scripts/jquery.validate/validate-register.js"></script>
<style type="text/css">
html, body {
	overflow: hidden;
}
</style>
<script type="text/javascript" src="../../scripts/cufon/cufon-yui.js"></script>
<script type="text/javascript" src="../../scripts/cufon/PSL_Kittithada_Pro___700.font.js"></script>
<script type="text/javascript">
	Cufon.replace('h2');
	Cufon.replace('h3');
	Cufon.replace('label');
</script>
</head>
<body id="register">

<!--$header_html-->

<div class="shadow-l"></div>
<div class="shadow-r"></div>
<div id="wrap-container" class="bg-type1">
  <div class="content">
    <h2>Register</h2>
    <div class="register-form">
      <div class="register-border">&nbsp;</div>
      <form action="" method="post" name="form-register" id="form-register">
        <div class="account-info">
          <h3>Account Information</h3>
          <ul>
            <li>
              <label class="usermname" for="username">Username :</label>
              <input type="text" name="username" id="username" class="username" value="" />
            </li>
            <li>
              <label class="member_scid" for="member_scid">Member Card Id :</label>
              <input type="text" name="member_scid" id="member_scid" class="member_scid" value="" />
            </li>
            <li>
              <label>Password :</label>
              <input name="password" type="password" id="password" class="password" value="" />
            </li>
            <li>
              <label>Re-enter Password :</label>
              <input name="password_confirm" type="password" id="password_confirm"  class="password_confirm" value=""  />
            </li>
            <li>
              <label>Email :</label>
              <input name="email" type="text" id="email" class="email" value="" />
            </li>
            <li>
              <label>Re-enter Email :</label>
              <input name="email_confirm" type="text" id="email_confirm" class="email_confirm" value="" />
            </li>
          </ul>
        </div>
        <div class="personal-info">
          <h3>Personal Information</h3>
          <ul>
            <li>
              <label>First Name :</label>
              <input name="first_name" type="text" id="first_name" class="first_name" value="" />
            </li>
            <li>
              <label>Last Name :</label>
              <input name="last_name" type="text" id="last_name"  class="last_name" value=""/>
            </li>
            <li class="gender">
              <label>Gender :</label>
              <input type="radio" name="gender" value="1" id="male" checked="checked" />
              <label for="male">Male</label>
              <input type="radio" name="gender" value="2" id="female" />
              <label for="female">Female</label>
            </li>
            <li>
              <label>Birthday :</label>
              <input name="birtday" type="text" id="birtday" class="birtday" value=""/>
            </li>
          </ul>
        </div>
        <div class="address-info">
          <h3>Address Information</h3>
          <ul>
            <li>
              <label>Company / Building Name :</label>
              <input name="company" type="text" id="company" class="company" value="" />
            </li>
            <li class="address">
              <label>Address No. :</label>
              <input name="address" type="text" id="address" class="address" value="" />
            </li>
            <li>
              <label>Road :</label>
              <input name="road" type="text" id="road" class="road" value="" />
            </li>
            <li>
              <label>Soi :</label>
              <input name="soi" type="text" id="soi" class="soi" value="" />
            </li>
            <li>
              <label>Subdistrict :</label>
              <input name="subdistrict" type="text"  id="subdistrict" class="subdistrict" value=""/>
            </li>
            <li>
              <label>District :</label>
              <input name="district" type="text" id="district" class="district" value="" />
            </li>
            <li>
              <label>Province :</label>
              <select name="province" id="province"  class="province">
                <option value="">เลือกจังหวัด</option>
                <!--$provinceOptions-->
              </select>
            </li>
            <li>
              <label>Postcode :</label>
              <input name="postcode" type="text" id="postcode" class="postcode" value="" />
            </li>
            <li>
              <label>Telephone :</label>
              <input name="telephone" type="text" id="telephone" class="telephone" value="" />
            </li>
            <li class="captcha">
              <label>Captcha*** :</label>
              <div class="captcha-img"><img src="/captcha/" /></div>
              <a href="#" id="refresh-captcha">Refresh Captcha</a> </li>
            <li style="width:166px; background:#000; margin-top:12px;">
              <input name="captcha" type="text" id="captcha" value=""   />
            </li>
            <li class="submit-register">
              <input name="submit" type="submit" id="submit" value="submit" />
            </li>
          </ul>
        </div>
      </form>
      <br class="clear" />
    </div>
  </div>
</div>

<!--$footer_html-->

</body>
</html>
